Differentiation of intellectual disability (ID) with depressive symptomology versus psychotic disorder utilizing multidisciplinary approach case report
Document Type
Article
Publication Date
6-10-2026
Publication Title
Personalized Medicine in Psychiatry
Abstract
Cognitive and behavioral features associated with lower intellectual functioning can overlap with psychotic symptom presentations, increasing the risk of misattribution in acute psychiatric settings where diagnostic overshadowing is common. We present a 45-year-old woman with a long-standing diagnosis of schizophrenia who experienced recurrent hospitalizations and prolonged antipsychotic exposure without sustained benefit. Her presentation had been consistently interpreted within a psychotic framework due to reports of “voices,” social withdrawal, fears regarding her family's safety, and impaired self-care. During an inpatient admission marked by minimal response to treatment, an individualized assessment incorporating cognitive profiling with the Wechsler Abbreviated Scale of Intelligence–Second Edition (WASI-II) revealed a pattern of functioning suggestive of mild intellectual impairment. Integration of these findings with longitudinal observation prompted reformulation of her symptoms. Her reported “voices” were reconceptualized as an internally generated negative self-talk in the context of her cognitive profile, rather than a psychotic process. Guided by the clinical presentation and cognitive profile of the patient, treatment was modified to prioritize antidepressant therapy and psychosocial interventions, alongside gradual tapering of antipsychotic medication. This approach was associated with improved engagement, increased participation in therapy, and reduced distress. This case highlights the value of individualized cognitive assessment in complex presentations, supporting more targeted, person-specific care and reducing unnecessary pharmacologic exposure, ultimately improving both individual outcomes and healthcare system efficiency.
Volume
57
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Recommended Citation
Barberito, Mandolin F.; Mermilliod, Isabelle V.; Bozner, Elizabeth M.; Hanson, Erik N.; Henning, Jeremiah A.; and Bierma, Shannon R., "Differentiation of intellectual disability (ID) with depressive symptomology versus psychotic disorder utilizing multidisciplinary approach case report" (2026). School of Medicine Faculty Publications. 4867.
https://digitalscholar.lsuhsc.edu/som_facpubs/4867
10.1016/j.pmip.2026.100190